The full outline of unresponsiveness score (FOUR score) is a grading scale for assessing the level of consciousness.
Scoring
This scale assesses four domains of neurological function:
eye responses (E)
motor responses (M)
brainstem reflexes (B)
respiratory (R)
Each is graded from 1 to 4 and the grades are added together so the lowest score is 0 and highest is 16.
Eye responses (E)
eyelids open: 4 points
eyelids open but voluntary tracking is absent: 3 points
eyelids closed but will open to loud voice: 2 points
eyelids closed but will open after pain stimulus: 1 point
eyelids remain closed in responding to the pain stimulus: 0 points
Motor responses (M)
obeys commands, e.g. for example patient can show "OK" sign, victory sign, show number by his/her fingers: 4 points
localizes to pain: 3 points
upper limbs will be flexed after pain stimulus: 2 points
extensor posturing after pain stimulus: 1 point
unresponsive to pain stimulus: 0 points
Brainstem reflex (B)
pupil and corneal reflexes are present: 4 points
one pupil is nonreactive and is dilated: 3 points
either the pupil reflex or corneal reflex is absent: 2 points
both pupil and corneal reflexes are absent but cough reflex during tracheal suctioning is present: 1 point
all reflexes such as the pupil, corneal and cough reflex are absent: 0 points
Respiratory (R)
not intubated and can breathe spontaneously and regularly: 4 points
not intubated but breathing pattern is abnormal - rate and depth of breath is changeable and abnormal and also breathing pattern is apneustic: 3 points
not intubated but breathing pattern is irregular: 2 points
intubated and ventilated by ventilator but the rate of patient breath is more than the set rate (rate of breathing in ventilator setting): 1 point
intubated and rate of breathing is equal to the set rate: 0 points
Interpretation
FOUR score is thought to provide more neurological detail than the Glasgow Coma Scale (GCS).